Download PDF
Am J Perinatol 2016; 33(05): 510-517
DOI: 10.1055/s-0035-1569988
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data

Mark A. Turrentine
1   Department of Obstetrics and Gynecology, Kelsey-Seybold Clinic, Houston, Texas
,
Laura C. Colicchia
2   Division of Maternal Fetal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Emmet Hirsch
3   Department of Obstetrics and Gynecology, NorthShore University HealthSystem and University of Chicago, Evansten and Chicago, Illinois
,
Po-Jen Cheng
4   Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Taoyuan, Taiwan
,
Teresa Tam
5   Department of Obstetrics and Gynecology, Presence Saint Francis Hospital, Chicago, Illinois
,
Patrick S. Ramsey
6   Division of Maternal Fetal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
7   Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
,
Sarah M. Page-Ramsey
8   Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
› Author Affiliations
Further Information

Publication History

17 July 2015

21 October 2015

Publication Date:
18 December 2015 (online)

    Permissions and Reprints

Abstract

Objective The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk.

Study Design A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel–Haenszel fixed effect model.

Results In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84–7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02–2.31).

Conclusion Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m2, race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.

Keywords

group B streptococcus - pregnancy - recurrence

Presented at the 63rd American College of Obstetrician and Gynecologist Annual Clinical and Scientific meeting, May 2–6, 2015, San Francisco, CA.


 

  • References

  • 1 Verani JR, McGee L, Schrag SJ ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1-36
    PubMedGoogle Scholar
  • 2 Cheng PJ, Chueh HY, Liu CM, Hsu JJ, Hsieh TT, Soong YK. Risk factors for recurrence of group B streptococcus colonization in a subsequent pregnancy. Obstet Gynecol 2008; 111 (3) 704-709
    CrossrefPubMedGoogle Scholar
  • 3 Turrentine MA, Ramirez MM. Recurrence of group B streptococci colonization in subsequent pregnancy. Obstet Gynecol 2008; 112 (2, Pt 1) 259-264
    CrossrefPubMedGoogle Scholar
  • 4 Tam T, Bilinski E, Lombard E. Recolonization of group B streptococcus (GBS) in women with prior GBS genital colonization in pregnancy. J Matern Fetal Neonatal Med 2012; 25 (10) 1987-1989
    CrossrefPubMedGoogle Scholar
  • 5 Page-Ramsey SM, Johnstone SK, Kim D, Ramsey PS. Prevalence of group B streptococcus colonization in subsequent pregnancies of group B streptococcus-colonized versus noncolonized women. Am J Perinatol 2013; 30 (5) 383-388
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Colicchia LC, Lauderdale DS, Du H, Adams M, Hirsch E. Recurrence of group B streptococcus colonization in successive pregnancies. J Perinatol 2015; 35 (3) 173-176
    CrossrefPubMedGoogle Scholar
  • 7 Edwards RK, Clark P, Duff P. Intrapartum antibiotic prophylaxis 2: positive predictive value of antenatal group B streptococci cultures and antibiotic susceptibility of clinical isolates. Obstet Gynecol 2002; 100 (3) 540-544
    CrossrefPubMedGoogle Scholar
  • 8 Turrentine MA, Ramirez MM, Mastrobattista JM. Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization. Infect Dis Obstet Gynecol 2009; 2009: 934698
    PubMedGoogle Scholar
  • 9 Stroup DF, Berlin JA, Morton SC , et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283 (15) 2008-2012
    CrossrefPubMedGoogle Scholar
  • 10 Wells GA, Shea G, O'Connell D , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. Available at: http://www.ohri.ca/programs/clinical epidemiology/oxford.asp . Accessed May 9, 2014
    PubMedGoogle Scholar
  • 11 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (1) 159-174
    CrossrefPubMedGoogle Scholar
  • 12 Lo CK, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments. BMC Med Res Methodol 2014; 14: 45
    Google Scholar
  • 13 Greenland S, Robins JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics 1985; 41 (1) 55-68
    CrossrefPubMedGoogle Scholar
  • 14 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7 (3) 177-188
    CrossrefPubMedGoogle Scholar
  • 15 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
    CrossrefPubMedGoogle Scholar
  • 16 Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315 (7109) 629-634
    CrossrefPubMedGoogle Scholar
  • 17 Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. JAMA 2006; 295 (6) 676-680
    CrossrefPubMedGoogle Scholar
  • 18 Stapleton RD, Kahn JM, Evans LE, Critchlow CW, Gardella CM. Risk factors for group B streptococcal genitourinary tract colonization in pregnant women. Obstet Gynecol 2005; 106 (6) 1246-1252
    CrossrefPubMedGoogle Scholar
  • 19 Regan JA, Klebanoff MA, Nugent RP. The epidemiology of group B streptococcal genitourinary tract colonization in pregnant women. Vaginal Infections and Prematurity Study Group. Obstet Gynecol 1991; 77: 604-610
    PubMedGoogle Scholar
  • 20 Van Dyke MK, Phares CR, Lynfield R , et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360 (25) 2626-2636
    CrossrefPubMedGoogle Scholar
  • 21 Fairlie T, Zell ER, Schrag S. Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease. Obstet Gynecol 2013; 121 (3) 570-577
    CrossrefPubMedGoogle Scholar
  • 22 Centers for Disease Control and Prevention. Active bacterial core surveillance report, emerging infections program network, group B streptococcus, 2013. http://www.cdc.gov/abcs/reports-findings/survreports/gbs13.pdf
    PubMedGoogle Scholar
  • 23 Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol 1996; 88 (5) 811-815
    CrossrefPubMedGoogle Scholar
  • 24 Verani JR, Spina NL, Lynfield R , et al. Early-onset group B streptococcal disease in the United States: potential for further reduction. Obstet Gynecol 2014; 123 (4) 828-837
    CrossrefPubMedGoogle Scholar